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General NPI Number Information
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NPI Number | 1427785054
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Entity Type | Individual
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Provider Name | JESSICA LIVERMONT OD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 221 S FLORENCE AVE STE 150
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City | CLAREMORE
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State | OK
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Zip | 74017-7263
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Country | US
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Telephone | 918-341-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 17816 E 626 RD
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City | TAHLEQUAH
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State | OK
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Zip | 74464-8757
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Country | US
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Telephone | 605-842-5132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3177
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License Number State | OK
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